NORTHERN HEALTH & SOCIAL CARE TRUST. Delegated Statutory Functions For Year end 31 March Summary Report

Transcription

1 NORTHERN HEALTH & SOCIAL CARE TRUST Delegated Statutory Functions For Year end 31 March 2013 Summary Report 1

2 1. Introduction This report is a summary of the main issues detailed in the Delegated Statutory Functions (DSF) annual monitoring return to the Health and Social Care Board (HSCB). A copy of the Trust s DSF Report is available on request. It has been a challenging year for the Trust in respect of compliance with the Scheme of the Delegated Statutory Functions. There have been pressures across all Directorates due to increased service demands alongside the need to balance stringent efficiency savings. Common to all Directorates has been the marked increase in safeguarding activity for adults and children with this impacting on Trust resources at various levels. The upward trend (31%) in adult safeguarding is a pattern similar to other Trusts; in the NHSCT it is anticipated this upward trend will continue into 2013/14. For Children Services whilst child protection registered numbers has risen by 13% over the annual period, the six months prior to March 2013 showed a slight decrease - a pattern similar across the region. 2. Professional Accountability Arrangements There is a direct line of accountability governing the discharge of statutory functions through the professional supervisory and operational line management arrangements up to the Executive Director of Social Work and Trust Board. Lead social workers have responsibility and accountability in their individual service areas for: provision of professional leadership to the social services workforce; promotion of learning and development opportunities; provision of specialist advice/guidance; reporting and related assurance arrangements in respect of the discharge of statutory functions. Bi - annual audits completed in year of adherence to Professional Supervision Policies evidenced considerable improvement in supervision practice and a high level of compliance across all Directorates. Action plans are in place to ensure continuous improvement with these being monitored by the Business Service Organisation and Trust operational and governance managers. The Annual HSCB monitoring of newly qualified social workers in their assessed year in practice (AYE) noted much higher numbers of AYEs in the Trust compared to elsewhere. This is partly due to trust wide recruitment practices for Band 5/6 social work posts. Although these numbers cause additional pressure on front line managers, monitoring evidenced high compliance with NISCC AYE Standards. Of the 61 employed AYEs (40 in Children s) some 46 were on temporary contracts. Workloads are managed according to the AYE level of experience and developing capability. Anticipated regional requirements on assessment of AYEs will have further impact for front line managers. 2

3 3. Statement of Controls The Trust meets its obligations in respect of controls assurance by having the following in place. i. Regulated services are subject to ongoing inspection by RQIA and Quality Improvement Plans are in place where appropriate and regularly reviewed ii. Policies and procedures operate informing the reporting and management of serious adverse incidents, near misses and monitoring of untoward incidents. The Trust also has a procedure in place for the dissemination of learning alerts in relation to the above. iii. Procedures are in place for the investigation, management and collection of information about complaints in relation to statutory services. iv. There is a programme of audit/service evaluation that includes follow-up improvement measures. v. The Trust s Professional Social Work and wider in house governance fora have a remit to review standards, policy/ legislation, address gaps in compliance and to ensure the discharge of statutory functions is continually reviewed. vi. Service user experience and feedback is considered from a range of sources such as reports informing RQIA inspections or the Trusts Homecare Annual Quality Report; the regional on line survey and external advocacy services for looked after children. In addition to the oversight of service user feedback provided via the trusts governance fora, the professional social work forum will analyse implications for professional practice. vii. Fitness to Practice reporting (bi-annual) to the Trust s General Management Board (GMB). This covers professional conduct issues and referrals to NISCC. viii. A registration policy for professional staff is monitored on an ongoing basis by operational managers and the Social Care Governance Department. NISCC learning and developments standards and other requirements are monitored annually as part of the training accountability return completed for the delegated statutory functions report. 4. Summary of Issues Impacting on Discharge of Delegated Statutory Functions by Directorate Below is a synopsis of key issues for each directorate. Mental Health and Disability Directorate i. Approved Social Workers continue to experience significant difficulties securing appropriate support from PSNI and Ambulance Service NI for conveyancing and assistance to undertake assessment. Trust staff are actively addressing this with PSNI and HSCB. ii. There is insufficient resource to provide detailed minutes of case discussions including vulnerable adults, guardianship, and promoting quality care complex assessments, (this period has seen 420 new referrals into the MHOP service). Reduction in administration staff over the past 3 years has resulted in professional expertise at times being utilised to undertake administration duties. iii. There was non-compliance with minimum standards within two residential EMI Units. Both units are built in an outdated model, room sizes, numbers of toilets, bathrooms and fabric of the building do not reflect best practice requirements for 3

4 people with dementia. Re- provision is a priority; both a business case and consultation about plans have been completed. iv. Although there has been a general reduction in permanent placements, there is ongoing demand to support discharges from the acute sector leading to increased demand for permanent placements. Temporary high level home base packages of care are provided to support families so that they can continue to care for their relatives at home. Aside from the additional financial pressure on the domiciliary care budgets, the higher levels of informal carers also means increased managed risks. v. There are insufficient funds to implement the Adding Life to Years Strategy thereby reducing the quality of service provided to people with dementia. Currently dementia sufferers are being cared for across 2 directorates. A working group (cross directorate) is established to prioritise work needed on the dementia care pathway. vi. There is lack of suitable accommodation within the mental health and disability directorate i.e. limited space to engage with service users and carers (this issue is also applicable to all directorates). vii. Information is not always easy to extract in the format required to inform Delegated Statutory Functions or other enquiries. A review of information systems and the related resource implications is planned. Physical Disability viii. ix. Lack of appropriate accommodation for service users with an acquired brain injury remains a concern. There are also insufficient services for those with progressive illnesses eg. multiple sclerosis, motor neurone, huntington disease. A business case has been developed (alongside supported living) and is currently with the HSCB. The physical disability programme has a number of service users living within the community who need 24 hour nursing care. These individuals require 2 specialist trained staff at any given time; this is proving an ongoing financial challenge Learning Disability x. Resettlement of long stay patients from Muckamore Hospital to community services remains a priority despite the community infrastructure challenges this poses post resettlement. The NHSCT successfully resettled 11 primary target list patients in 2012/13 and 4 delayed discharge patients. xi. Provision of specialist mental health intervention and psychological therapies for people with learning disabilities is limited. Development of forensic services within this programme of care remains a priority. xii. There is continued development of a trust wide service for family based respite and adult services within the learning disability programme of care. Approximately 250 service users avail of community based Share the Care respite; permanent placements, day respite and overnight respite have also been further developed. Plans are underway to address gaps in these community based services within the Larne/Carrick/Newtownabbey localities. xiii. There are increasing numbers of young adults with learning disability or autism that need specialist buildings based respite post school. To date the Trust has met this demand within existing resources/funding but the growing need does require a more sustainable approach in the future. 4

5 xiv. Safeguarding referrals in learning disability have risen from 93 to119 (28% increase). Due to reconfigured structures within learning disability the numbers of trained designated officers reduced and this impacted on the ability to respond to referrals within stipulated timeframes. Agreement that band 7 social work practitioners can now undertake this role should resolve this difficulty. Primary Care and Community Care for Older People s Services Directorate i. In response to Transforming Your Care (TYC) the Trust has initiated changes in how services will be delivered in the future. Long term planning is already underway with regard to residential accommodation. Trust staff continue to work in partnership with individuals, families and relevant stakeholders to successfully resettle residents where this has been the agreed plan. Trusts across Northern Ireland, along with the HSCB, are now developing further proposals in respect of particular homes in the region. ii. The increase in Failure to Comply Notices by RQIA in residential and nursing homes has impacted greatly on staff workloads at all levels. A recently developed information system to track increases in failure notices will also assist staff monitor progress towards compliance. Staff must urgently review service users, meet with families /home owners and if appropriate re-assess or possibly arrange for new placements where failure notices are in place. iii. Safeguarding referrals have risen from 130 to 162 (25% increase). Some safeguarding activity linked to independent residential and nursing homes have entailed complex, time consuming investigations and management of public and media attention. This has impacted on the work of the permanent placement team in terms of other professional responsibilities. iv. The development of the Out of Hours Homecare Service is on-going. The current delivery model is based on staff opting to work additional hours; the voluntary nature of this arrangement will need reviewed should the service prove unsustainable. There are on-going negotiations with unions and staff to ensure a fully operational Home Care out of Hours Service is in place prior to the commencement of the Regional Emergency Social Work Service. v. There remains significant shortfall between the base line and back fill funding to release staff to meet RQIA training requirements for homecare. A bid was made and secured from the year 2012 slippage monies as one off funding. Work to identify the full cost of induction, mandatory, additional or refresher training has been completed and will be utilised to inform future discussions. vi. There continues to be ongoing liaison with RQIA as to how best meet the standards and training requirements applicable to the control and administration of medicines in domiciliary care settings. vii. Estate Standards as specified by RQIA for Residential and Day Care remain an on-going challenging for the Directorate and is closely monitored by the Head of Service for Day/Residential Care. viii. Use of the NISAT tool underpinning multidisciplinary assessment has improved throughout the year with staff building competence and confidence using the tool in partnership with service users. The e-nisat tool is being phased in and currently takes considerable administrative and professional time (includes uploading historical assessments). There are long term financial issues such as IT infrastructures or sufficient supply of hand held devices to support multidisciplinary professional assessments (a cross directorate issue). The application of NISAT is to be evaluated by RQIA in 2013/14. 5

6 ix. The DHSSPS Value for Money (VFM) Audit covering the Social Services Adult workforce is to be issued in June This highlights low numbers of Band 6 social workers progressing to Band 7 social work posts and the impact this has on supervision arrangements particularly within integrated teams. The report also explores staff activity (ie, direct contact with clients, assessment, administration tasks and workload). Account of final VFM report recommendations will be considered when available. Acute Hospital Services i. There has been a marked increase in the number of discharges which require risk management/discharge planning meetings, co-ordinated by the hospital social workers (HSW). An additional temporary social work resource has helped meet increasing demands. ii. A Review of HSW will focus on strengthening the hospital and community interface and taking account of delivery models in line with Transforming Your Care priorities. It will also consider issues such as, current working patterns and pressures on HSW due to increased numbers of patients being discharged from acute hospital beds. iii. The requirement for HSW to provide a quality social work service to patients with increasingly complex needs, (includes assessment, safeguarding, and care planning) within the PFA discharge target is challenging for hospital social work. Work is ongoing to improve systems across the HSW and community interface. iv. Providing a 7 day HSW service is only partly met by the current weekend/bank holiday arrangements; further planning has been initiated to provide the full cover required. A draft option appraisal on this issue is with senior management for consideration. Children s Services Directorate A joint HSCB/NHSCT Review of Social Care Activity and Expenditure is to be finalised shortly. This is highlighting sustained increases in demand for services within the Children s directorate. Findings from the Review support the view that current activity is unsustainable in the longer-term; this and related resourcing implications will be considered in due course with the HSCB The high turnover of staff within children s services due to long term sick leave, maternity leave or short term posts is a concern. Difficulty recruiting to certain front line teams has been an ongoing problem leading to some children and families having more frequent changes of social worker than desirable. This also has an impact for unallocated cases. Targeted solutions must be found to stabilise the workforce in the known hot spot areas. 6

7 Safeguarding and Family Support i. Numbers of children on the Child Protection Register (CPR) was 525 at the end of March 2013 representing a 13% increase from the the year previously. This however is a slow but consistent decrease from the figure of 570 at the end of November The Trust is introducing Independent Chairs for Child Protection Conferences to ensure greater consistency in the application of registration criteria. ii. Independent Chairing will also assist ensuring Child Protection Case Conferences are held within the 15 day target timescale. Breeches to the target were mainly in the pre birth category with all delayed conferences being held within 1or 2 days. A Child Protection Case Conference Audit (Dec 2012) noted the good quality of social work reports provided to assist decision making. iii. Increasing numbers of cases being carried by Children s Services staff has led to severe pressures particularly in family support and intervention teams. The Children in Need referral figure has risen from 4,634 (March 2012) to 5,052 (March 2013) representing a 9% increase. This upward trend contributed to ongoing problems to reduce unallocated cases. iv. Referrals of a highly complex nature require senior social workers to prioritise these against risk management thresholds which is reflected in increased in CPR figures. However there remains a high level of other unallocated child care cases (157 cases at March 2013). This figure is a decrease from 225 at September 2012 and reflects both improvement activity and the Trust supporting several front line posts as unfunded cost pressures. Roll-out of a Family Support Model and future voluntary sector partnership arrangements should help reduce numbers of unallocated cases. v. Neglect is the highest category of abuse (31%) and 5-11 year olds (37%) are the highest age group within regional CPR figures. This accurately reflects the NHSCT profile and is factored into planned family support initiatives. vi. There has been a marked decrease in the numbers of cases awaiting allocation for a Family Centre Service although waiting lists still remain for Step 3 CAMHS services (these have decreased from 384 to 182, a 52% reduction). The decreases are due to the service introducing more efficient ways of working as opposed to any reduction in demand. The Trust is currently finalising a bid to the HSCB with respect to ring fenced funding. Other agreed new investment will focus on Step 4 CAMHS development of a Primary Mental Health Service and Crisis Resolution Home Treatment Team. vii. At the end of March 2013 there were no breaches against the CAMHS PfA target that all children be seen within 9 weeks. This represents significant improvement initiatives put in place by CAMHS staff. viii. There has been a 5.5% (744 to 785) increase in the number of disabled children known to the trust in this reporting period, the largest category being children with a learning disability. ix. An Early Years Improvement Plan implemented from September 2012 has eliminated all overdue registrations and inspections. The plan utilised process mapping, a review of structures and roles and responsibilities which has now led to this service being fully compliant with its Delegated Statutory Functions. x. Implementation of the regional caseload management model indicates that frontline teams and looked after children teams are typically working at or beyond the recommended regional maximum levels. This issue will be followed up with the HSCB and has been factored into the Financial Review and Activity Report. 7

8 Looked After Children i. There has been an 11% increase in the number of Looked After Children (LAC) since the previous year from 634 to 701 (March 2013). Overall the percentage increase in LAC in the past 2 years is 21%. This has made it difficult to fully meet statutory LAC Reviews timescales ( of the 45 outside of timescale 31 of these was due to non attendance of key decision makers needed for court processes, mainly parents/carers ) ii. Teams are holding increasing numbers of looked after children living at home in situations with complex child protection issues and where court processes are pending. Many of these (and other children cared for elsewhere) are subject to court directed supervised contact. This is a regionally shared concern to be explored with the Judiciary. A number of additional staffing costs have been carried as unfunded cost pressures to help deal with these pressures. iii. Given increased Looked After figures, ability to provide appropriate short and long term placements has been difficult and continued use of high cost intensive support placements has occurred. The Trust is constantly seeking innovative ways to recruit a diversity of carers (including supporting people initiatives). The family placement service is in the process of being restructured to facilitate more streamlined assessments of potential carers and to focus inputs on fee paid foster parents who care for children with the most challenging and complex needs. The new fostering management team is targeting the 99 outstanding annual foster care reviews for attention. This figure is down from 165 (40% reduction) since September iv. Kinship care continues to present challenges on family placement assessment/link work activity due to the complexity of placements and involvement of courts and Guardian ad Litem Service. v. Permanence planning and adoption services continue to progress with best interest decisions (24 obtained), freeing orders (22 granted) and children successfully adopted (16). This increase in adoption work has placed further pressure on the adoption support team and also in the work undertaken by the TTLAAC team (a therapeutic service). vi. The new Intensive Support Residential Unit (ISU) is well underway and will be fully operational by September 2013; this will provide an intensive support service sitting alongside the newly created specialist fostering service. Its primary aim will be to return children to their family environment as quickly as possible. vii. There is continued work with supporting people and voluntary providers to establish an additional 24 residential beds for over 16 + LAC. This should help reduce usage of unregulated placements of which there were 8 in this reporting period. viii. The shortfall in the number of personal advisors (PAs) remains a concern and a recruitment plan has been initiated to address this. Given the difficulties regionally in respect of recruitment of PAs, the HSCB recently produced a strategy paper which the Trust will consider alongside Board colleagues. 8

9 5. Achievements Trust staff successfully achieved or supported achievement of awards in a number of areas as detailed below: Regional Social Work Awards 2012: Runner up awards in specific categories Individual categories- Phil Hughes (Adults) and Ruth Kernohan (Children s) Partnership category - Mental Health and Older People Dementia Centre Awards 2012 Three separate awards for the most outstanding Dementia Friendly Organisation and the Dementia Design Innovation Award of the Year. (Mental Health and Older People) Sharing Excellence/Leading Quality Awards 2012 First Place Quality Initiative Award: TTLAC team: Consultation and support for young people in care (Children s) Runner up Awards: - Day Opportunities (Learning Disability) Team of the Year - Day Centre Reablement programme (PCCOPS) Improvement Initiative - NI Fire and Rescue Service (Physical Disability/Sensory Support) Best Safety Initiative team: DVD production for LAC (Children s) - PAL Service: multi media resources addressing sexual exploitation (Children s) NI Art Care Bursary Award 2012 Awarded to a Looked after Young Person (Children s residential team) Artwork exhibited at Waterfront Exhibition Centre, Belfast Fostering Achievement Awards 2012 Several achievement awards obtained by young people placed with Trust carers. British Heart Foundation Awards 2012 Foundation Award for Partnership (Learning Disability & Cookstown District Council) Patient & Client Council Awards Finalist Award in Health and Well Being category (Physical Disability) Other Successes Publication of a Diabetes Booklet produced by staff in Learning Disability is to be rolled out regionally In conjunction with Reminiscence Network NI staff within the PCCOPS Directorate have further developed Sharing Memories Building Communities in Trust Day Centres. The Homecare Reablement Service (PCCOPS) is successfully supporting people in their own homes to regain independence following an acute or critical health event. 9

10 Hospital Social Worker Jackie Cassidy and a service user shared their perspectives of the Oncology Support Group at the Trust s Social Work Conference Three children s services staff presented at an international conference (Cornell University) on the implementation of the CARE model. The Employability Scheme continues to successfully find training, employability and education opportunities for young people leaving care (16+). 6. Conclusions The issues highlighted in this report reflect the hard work and dedication of staff to address responsibilities for delegated statutory functions over the past 12 months. Many individuals at all levels in the Trust have worked collaboratively to ensure the DSF Report itself represents the challenges facing the trust at a time of uncertainty and change. In line with normal monitoring the Trust has met with the HSCB to discuss findings reported within the Delegated Statutory Functions Report and this was a generally positive meeting. The HSCB acknowledged the work being undertaken, noting significant progress in many areas. Issues of most concern centred on the impact of increased demand on services across all Directorates, particularly in respect of Safeguarding activity and numbers of Looked After Children. Several actions have been agreed which are now being taken forward by Trust and HSCB colleagues in both these areas. 10